Transoral laser surgery of supraglottic cancer - Follow-up of 141 patients
Transoral laser surgery of supraglottic cancer - Follow-up of 141 patients
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DOI：
10.1001/archotol.124.11.1245
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发表时间：
1998-11-01
影响因子：
--
通讯作者：
Steiner, W
中科院分区：
文献类型：
--
作者：
Iro, H;Waldfahrer, F;Steiner, W
目的：探讨经口激光切除声门上癌的作用。设计：回顾性单中心研究1979年2月至1993年12月间经口二氧化碳激光显微手术治疗声门上癌的肿瘤学结果。中位随访时间为37个月。单位：大学医院三级学术转诊中心。患者：我们回顾了141例经组织学证实的声门上癌患者（连续131例男性和10例女性，平均年龄60岁）的医疗记录，这些患者接受经口激光手术，可能联合颈部清扫或放疗。患者分期分布如下：I期占23.4%；第二阶段，25.5%；III期，16.3%；IV期34.8%（根据国际抗癌联盟分期系统）。主要观察指标：无复发生存率、局部和区域复发率。结果：5年无复发生存率：总病例数65.7%；第一阶段，85.0%；II期，62.6%；根据国际癌症联盟的分期系统，III期为74.2%，IV期为45.3%。局部复发率为16.3%，局部复发率为9.9%。结论：经口二氧化碳激光手术若能达到干净的切缘（RO），其肿瘤学效果是满意的。对于无法切除肿瘤边缘（R1和R2切除）且无法经口翻修的患者，应进行经颈手术（部分或全喉切除术）。经口声门上喉切除术对T3病变的适应症应慎重考虑。
Objective: To determine the role of transoral laser resection of supraglottic carcinomas.Design: Retrospective unicenter study of the oncologic results of transoral carbon dioxide laser microsurgery for supraglottic carcinomas performed between February 1979 and December 1993. Median follow-up was 37 months.Setting: University hospital academic tertiary referral center.Patients: We reviewed the medical records of 141 patients (a consecutive sample of 131 men and 10 women; mean age, 60 years) with histologically proven supraglottic carcinomas undergoing transoral laser surgery, possibly in combination with neck dissection or radiotherapy. Stage distribution of patients was as follows: stage I, 23.4%; stage II, 25.5%; stage III, 16.3%; and stage IV, 34.8% (according to the Union Internationale Contre le Cancer staging system).Main Outcome Measures: Recurrence-free survival rates and local and regional recurrence rates.Results: Five-year recurrence-free survival rates were as follows: the whole case load, 65.7%; stage I, 85.0%; stage II, 62.6%; stage III, 74.2% and stage IV, 45.3%, according to the Union Internationale Contre le Cancer staging system. The local and regional recurrence rates were 16.3% and 9.9%, respectively.Conclusions: The oncologic results of transoral carbon dioxide laser surgery are satisfying if clean surgical margins (RO resection) can be reached. In patients in whom tumor-free margins are not achieved (R1 and R2 resection) and transoral revision is not possible, transcervical procedures (partial or total laryngectomy) should be performed. The indication for transoral supraglottic laryngectomy in T3 lesions should be considered with restraint.